YUSUF LOPEZ
Dependent on policy B02M000518
Claims
2
Attributed to this person
Charged
977.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
131.20
Reported on the 835
Patient responsibility is the amount reported on the 835 as assigned to the patient — deductible, coinsurance or copay. It is not proof that the provider billed the member, that the member owes it, or that it was collected, and it is kept separate from denied amounts throughout.
Who this is
| Field | Value |
|---|---|
| Name | YUSUF LOPEZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B02M000518 |
| Date of birth | 8 Aug 1962 |
| Plan | PLATINUM PPO |
| Covered from | 19 Feb 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 131.20 |
| Total | 131.20 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002193 | 4 Apr 2026 | 656.00 | CASCADE CARE | Not denied | — |
| CLM0002192 | 4 Mar 2025 | 321.00 | CASCADE CARE | Not denied | — |